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Full text of "Diseases Of The Nose Throat And Ear"

NECK MASSES

241

the anterior border of the sternomastoid muscle. It is cystic and quite
lobile in all directions. If the fluid is aspirated it will be found to contain
lolesterol crystals. Cysts in this position have their internal opening just
shind the posterior pillar of the fauces. On occasion they may occur in the
pper third of the sternomastoid muscle and mimic a parotid swelling by
ashing the tail of the parotid outwards. These cysts represent remnants from
te first branchial cleft and open internally at the junction of the bony and

Fig. 123. Thyroglossal cyst.

r—ifc    -        .

Fig. 124. Branchial cyst.

artilaginous external auditory meatus. As well as presenting as a mass t(Ney
lay also cause a discharging ear.

Cervical ribs, if large, may simulate a stony hard lymph node in the
art of the posterior triangle. The fact that they are the only structures
re stony hard in that area is helpful in the diagnosis.

Laryngocele is dealt with in Chapter 36 (p. 176). It is a remnant QJ
rimitive air sac and presents at the side of the neck over the thyro]
aembrane. It may be easily inflated and emptied of air, and it shoj
haracteristic radiographic appearance. Sometimes the  mouth of t;
ecomes blocked, infection supervenes and the presentation is that
yocele.

. Tuberculosis. This classically affects the lymph nodes in the
Drmerly it was not uncommon for the glands to involve the skin and t

discharging sinus. Nowadays this is rare because such enlarged neck
re usually dealt with at a much earlier stage. Tuberculosis commonly
lands in the deep jugular chain around the carotid bulb and
he glands in the posterior fossa are aifected. As the glands enlarge
o become intimately associated with the walls of the major blood
his makes excision difficult. While many cases have associated pi
uberculosis, the neck glands may be the only manifestation of the
The treatment is to excise one or two glands for biopsy, and to treat tfeefbafter
vith the appropriate chemotherapy.